Transmission of Mycobacterium tuberculosis from tuberculosis patients with HIV infection or AIDS.

Contacts exposed to tuberculosis patients with acquired immunodeficiency syndrome (AIDS) or human immunodeficiency virus (HIV) infection were compared with contacts of HIV-negative patients for evidence of Mycobacterium tuberculosis transmission, based on a review of records of tuberculin skin tests administered during routine health department follow-up investigations in Miami/Dade County, Florida, from 1985 through 1989. After an adjusted analysis designed to balance background prevalence, tuberculin positivity was 42.0% in 2,158 contacts of HIV-negative patients compared with 28.6% and 31.3% in 363 contacts of HIV-infected patients and 732 contacts of AIDS patients, respectively. Similar results were observed in a subset of 5- to 14-year-old contacts of United States-born black or white tuberculosis patients chosen to minimize the possibility of false-negative tuberculin tests in contacts due to undiagnosed HIV infection. Analysis of contacts as sets showed a more than expected number of sets with none or all contacts infected, but this did not differ by HIV/AIDS group. In this study, tuberculosis patients with AIDS or HIV infection were less infectious to their contacts and, in this community, exposed fewer contacts than HIV-negative tuberculosis patients.

Florida's tuberculosis epidemic. Public health response.

Florida ranked fourth in the nation with 1,707 tuberculosis cases reported in 1992 for a rate of 12.7 per 100,000 population. Thirteen percent of these patients had AIDS. Recent cases in prisons, shelters, hospitals and schools have stimulated interest and media coverage. Resurgence of strains of multiple-drug resistant tuberculosis is a serious concern. The Florida Department of Health and Rehabilitative Services, in collaboration with allied agencies, has utilized several initiatives in response. The most significant, Tuberculosis Epidemic Containment Plan, details intervention strategies needed to eliminate TB in the state by the year 2010. Successful implementation depends upon local TB prevention and control coalitions that include private and public sector providers.

Pediatric tuberculosis and human immunodeficiency virus infection in Palm Beach County, Florida.

OBJECTIVE: To describe the factors underlying an increasing incidence of tuberculosis in children. DESIGN: Descriptive case review. SETTING: Palm Beach County, Fla. PARTICIPANTS: Forty-four children with suspected and confirmed pediatric tuberculosis from 1985 through 1989. INTERVENTIONS: None. MEASUREMENTS/MAIN RESULTS: From 1988 through 1989, tuberculosis was confirmed in 15 children and suspected in another 16 compared with data from 1985 through 1987 in which the disease was confirmed in nine children and suspected in four. Pediatric tuberculosis occurred primarily in blacks younger than 5 years; the increase in the number of cases reported in 1988 and 1989 occurred only in blacks. One child in whom tuberculosis was confirmed during the recent period was infected with the human immunodeficiency virus (HIV); however, among children with suspected tuberculosis, four of the nine children tested were seropositive for HIV. There was no evidence of increased transmission of tuberculosis to children by HIV-seropositive adults compared with transmission by HIV-seronegative adults with TB. New adult tuberculosis cases in the county increased annually, from 92 cases in 1986 to 169 in 1989, of whom at least 36% were infected with HIV. CONCLUSIONS: The largest effect of the HIV epidemic on tuberculosis in children appeared to be indirect, through an increase in the number of adults with active tuberculosis serving as potential sources of tuberculosis infection for children. A direct effect of HIV infection in the progression of tuberculous disease in children is likely, but was not detected in this investigation. Case-finding for tuberculosis among children will need to increase, particularly in areas heavily affected by acquired immunodeficiency syndrome, but may be complicated by the difficulty of diagnosing tuberculosis in HIV-infected children.

Surveillance and epidemiologic mapping of monoclonal antibody-defined rabies variants in Florida.

Brain tissues from 128 rabid animals from Florida in 1987 and 1988 were analyzed with monoclonal antibodies and cases were mapped by species and antigenic variant. The single variant found in terrestrial animals was distinguished easily from the variety of antigenic variants identified for infected bats, and there was no evidence of transmission of rabies between bats and terrestrial animals. The raccoon (Procyon lotor) appeared to be the sole maintenance source for terrestrial animal rabies in Florida.

Multiple sclerosis in Key West, Florida.

In 1984, a press release by a Miami, Florida, neurologist described a possible cluster of persons with multiple sclerosis in Key West, Florida. The authors examined the cluster using prevalence rates, which are recognized as having a latitudinal gradient for multiple sclerosis, being generally high at high latitudes and low at low latitudes. Case ascertainment showed 32 definite or probable cases among residents of the study area (latitude, 24.5 degrees N) on September 1, 1985, a prevalence rate of 70.1/100,000 population--14 times the rate estimated for this latitude by modeling techniques based on US and international data, 7-44 times the rate for areas at similar latitudes (Mexico City, Mexico; Hawaii; New Orleans, Louisiana; and Charles County, South Carolina), and 2.5 times the expected rate for all US latitudes below 37 degrees N. This finding could not be explained by changes in diagnostic criteria, case ascertainment bias, immigration of people from high-risk areas, an unusual population structure, a large percentage of related cases, or better survival. Prevalent cases (n = 22) were more likely than general population controls (n = 76), matched by sex and 10-year age group, to have: lived longer in Key West, been a nurse, ever owned a Siamese cat, had detectable antibody titers to coxsackievirus A2 and poliovirus 2, and ever visited a local military base (Fleming Key). Key West has an unusually high prevalence of multiple sclerosis that may be related to these risk factors.

Tuberculosis and acquired immunodeficiency syndrome--Florida.

Florida reported 1858 cases of the acquired immunodeficiency syndrome (AIDS) and 8455 cases of tuberculosis from January 1, 1981, through October 31, 1986. Of the patients with AIDS, 159 (8.6%) also had tuberculosis, and 154 (1.8%) of the patients with tuberculosis also had AIDS. Among patients with both diagnoses, tuberculosis was diagnosed before AIDS by more than 1 month in 50%, was diagnosed within 1 month before or 1 month after the diagnosis of AIDS in 30%, and was diagnosed more than 1 month after the AIDS diagnosis in 20%. Compared with patients with AIDS only, patients with both diagnoses were also more likely to be Haitian, black (other than Haitian), or Hispanic. Compared with patients with tuberculosis only, patients with both diagnoses were more likely to be younger, male, Haitian, black (other than Haitian), and Hispanic, have extrapulmonary tuberculosis and negative tuberculin skin tests, and have noncavitary chest roentgenograms. These data suggest that patients with AIDS may have an increased risk of tuberculosis and that patients with both diagnoses differ in important demographic and clinical characteristics from patients with AIDS only or tuberculosis only.

Epidemic campylobacteriosis associated with a community water supply.

In May 1983, an estimated 865 cases of epidemic gastrointestinal disease occurred in Greenville, Florida. Surveillance of pharmacy sales of antidiarrheal medicines suggested that the outbreak was confined to Greenville and its immediate vicinity. Surveys demonstrated that the gastrointestinal illness attack rates inside and outside the city limits were 56 per cent (72/128) and 9 per cent (7/77), respectively (relative risk (RR) = 6.2); consumption of city water was associated with illness (RR = 12); and as water consumption increased, the attack rate also increased (p less than 0.001). Four adults were hospitalized and one outbreak-related case of Guillain-Barre' syndrome was identified. Campylobacter jejuni was isolated from specimens from 11 ill persons; serologic studies showed the development of Campylobacter-specific antibodies. Fecal coliforms were found in water samples, but Campylobacter was not recovered from water. The city water plant, a deep well system, had numerous deficiencies including an unlicensed operator, a failure of chlorination, and open-top treatment towers. Birds were observed perching on the open-top treatment tower. Of 38 birds trapped seven weeks later, 37 per cent harbored C. jejuni; however, plasmid and serotyping studies showed that strains were not the same as the common strain from ill persons. This outbreak suggests that water systems that are unprotected from contact with birds may become contaminated and a source of outbreaks of human campylobacteriosis.

Persistence of rabies antibody in free-ranging raccoons.

The immune status of a wildlife population to rabies virus probably influences the occurrences of epizootics among that species in a given geographical area. This is not to say that enzootic transmission of the virus will not occur, but rather that attainment of epizootic levels may be hampered through herd immunity. After an epizootic of rabies in a raccoon population in the Fall of 1970, a serologic surveillance program was initiated from November 1970 through August 1974. The surveillance provided the opportunity to determine the persistence of antibody in individual animals as well as to compare the sensitivity of intracerebral mouse inoculation and the RFFIT. The average point prevalence of neutralizing antibody was 20.9% (range, 15.5% [1970] to 25.0% [1974]). Fifty-one (18%) of the 476 raccoons monitored during the study period were trapped more than once. The testing of sequential serum samples from individual seropositive raccoons indicated that serum neutralizing antibody can persist for at least 37 months. It cannot be stated with certainty that these antibody titers resulted from a single exposure to rabies virus and were not boosted by further experience with the virus. Serial serology tests on three young raccoons (less than 15, 30, and 52 weeks of age) suggest that endemic rabies virus was circulating in or near the study area between June 1972 and February 1974. Thirty-six raccoons trapped in November 1970 were shipped to the Centers for Disease Control, Lawrenceville, Ga, where they were held in captivity for observations and serologic monitoring.(ABSTRACT TRUNCATED AT 250 WORDS)

Human enteroviruses and wildlife: isolation from gray squirrels.

Five isolates of human echovirus 1/8 complex were recovered from the feces of free-ranging gray squirrels. The source of infection and the significance of the isolates remain unknown.

Serologic survey for Toxoplasma gondii in wild animals in Florida.

Blood samples were collected for serum separation from 114 species of wild animals (25 species of mammals, 82 species of birds, and 7 species of reptiles) in Florida. Each of the 3,471 samples was tested for antibodies to Toxoplasma gondii, using the indirect hemagglutination test. The highest prevalences of T gondii antibodies were 19% in armadillos (Dasypus novemcinctus), 18% in raccoons (Procyon lotor), 13% in black rats (Rattus rattus), and 11% in opossums (Didelphis marsupialis). Antibody prevalences were significantly higher in male than in female raccoons (P less than 0.05) and in adult than in nonadult raccoons and opossums (P less than 0.005). A high proportion of seropositive animals was found in three other mammalian species: 4 of 4 black bears (Ursus americanus), 2 of 3 bobcats (Lynx rufus), and 2 of 8 Norway rats (Rattus norvegicus) tested. Antibodies were found in 8 of the 1,279 avian serums; they were not found in any of the 13 reptilian serums tested. There were no significant geographic variations in antibody prevalence in any species.

Occurrence and distribution of western equine encephalomyelitis in Florida.

Research and surveillance programs relating to the occurrence and distribution of western equine encephalomyelitis virus in Florida, conducted between 1955 and 1976, suggest that the virus is (1) an endemic arbordae, (2) transmitted in a continuous cycle throughout the year by Culiseta melanura mosquitoes, and (3) restricted to fresh water swamps and waterways in central, north, and northwest Florida.

Trends of brucellosis in Florida. An epidemiologic review.

Human brucellosis in Florida is documented for the 47-year period 1928-1975. Of the 936 cases reported in 1930-1975, more than half (505) occurred in the decade 1940-1949. The incidence declined rapidly to an average rate of five cases per year, although there was an increase in 1974 and 1975. The analysis is mainly concerned with the years 1961-1975, since more complete epidemiologic data are available for this period. Cases occurred throughout the year, with the highest incidence being between May and August. White males in the 25-35 and 35-44 deciles were most affected. Of occupations identified between 1963-1975, 44% were related to the livestock-producing industry, 16% to the meat processing industry and 28% to hunters, housewives, students and children. Twelve per cent of the cases did not fall in any of these categories. Cattle were the most probable source of human infection in the livestock industry, and swine were associated with most non-industry cases. In 1963-1975, B. suis was isolated from 10 cases and B. canis from one case; one other isolate was not identified beyond genus. Of the 27 human cases recorded during 1974-1975, 15 (56%) involved swine contact (five livestock industry, four consumers and six hunters), 11 (41%) involved cattle contact (all from the livestock and meat packing industries), and one involved contact (with both cattle and swine (livestock industry). Human cases contracted from swine were scattered statewide, whereas cases associated with cattle only occurred in counties that had )( high densities of cattle and 2) modified-certified ratings in the Brucellosis Eradication Program.

Heavy metal concentrations in kidneys of estuarine raccoons from Florida.

Concentrations of lead, zinc and cadmium in the kidneys of 14 adult raccoons from an estuarine environment were determined. The mean concentrations in ppm wet weight and standard deviation for the metals were lead--0.47 +/- 0.22, zinc--75.88 +/- 16.54 and cadmium--2.48 +/- 1.66.